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中华疝和腹壁外科杂志(电子版) ›› 2025, Vol. 19 ›› Issue (01) : 46 -50. doi: 10.3877/cma.j.issn.1674-392X.2025.01.009

论著

机器人辅助腹腔镜造口旁疝修补术七例报道
李宝山1, 王荫龙1,(), 张新1, 满艺1, 黄皇1   
  1. 1.300121 天津市普通外科学重点建设学科实验室 天津市人民医院疝和腹壁外科
  • 收稿日期:2024-08-23 出版日期:2025-02-18
  • 通信作者: 王荫龙
  • 基金资助:
    天津市医学重点学科(专科)建设项目资助(TJYXZDXK-058B)

Robot-assisted laparoscopic parastomal hernia repair:a report of 7 cases

Baoshan Li1, Yinlong Wang1,(), Xin Zhang1, Yi Man1, Huang Huang1   

  1. 1.Tianjin Key Laboratory of General Surgery Inconstruction.Department of Hernia and Abdominal Wall Surgery, Union Medicine Center in Tianjin, Tianjin 300121, China
  • Received:2024-08-23 Published:2025-02-18
  • Corresponding author: Yinlong Wang
引用本文:

李宝山, 王荫龙, 张新, 满艺, 黄皇. 机器人辅助腹腔镜造口旁疝修补术七例报道[J/OL]. 中华疝和腹壁外科杂志(电子版), 2025, 19(01): 46-50.

Baoshan Li, Yinlong Wang, Xin Zhang, Yi Man, Huang Huang. Robot-assisted laparoscopic parastomal hernia repair:a report of 7 cases[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2025, 19(01): 46-50.

目的

探讨机器人辅助腹腔镜造口旁疝修补术(Sugarbaker)可行性及疗效。

方法

回顾性分析2024 年3—7 月天津市人民医院完成的7 例机器人辅助腹腔镜造口旁疝修补术的临床资料。所有患者修补方式均为Sugarbaker。观察记录患者手术情况,包括手术时间、术中并发症(术中大出血、肠损伤)、机器人系统故障发生情况;术后恢复情况,包括术后进水、进食时间,术后排气、排便恢复时间,术后第1 天疼痛程度及术后住院时间。随访出院后并发症,包括造口感染、肠梗阻及疝复发情况。

结果

7 例患者手术均顺利完成,无术中并发症及机器人系统故障发生,手术时间150~240 min,术中出血量10~50 ml,无术中输血;所有患者术后6 h 进水,术后1 d 进流食。恢复排气时间1~3 d,平均1.57 d;恢复排便时间2~4 d,平均2.86 d。术后疼痛轻,术后第1 天疼痛数字分级评分2~4 分,平均2.71 分。术后住院时间4~5 d,平均4.29 d。随访1~4 个月,术后肠梗阻1 例,保守治疗后缓解,无造口感染和复发病例。

结论

机器人辅助腹腔镜造口旁疝修补术安全有效,并发症发生率和短期复发率较低,但远期效果有待进一步观察。

Objective

To explore the feasibility and efficacy of robot-assisted laparoscopic parastomal hernia repair (Sugarbaker).

Methods

A retrospective analysis was conducted on the clinical data of 7 cases of robot-assisted laparoscopic parastomal hernia repair completed in Union Medicine Center in Tianjin from March 2024 to July 2024.The method of All patients repaired was Sugarbaker.Observe and record the surgical situation, including operation time, intraoperative complications (intraoperative hemorrhage, intestinal injury), and the occurrence of robotic system failure; postoperative recovery,including postoperative water intake, eating time, postoperative exhaust and defecation time, pain level on the first day after surgery, and postoperative hospital stay.Follow up the post-discharge complications,including stoma infections, intestinal obstruction, and hernia recurrence.

Results

All seven patients successfully underwent surgery without intraoperative complications or robotic system malfunctions.The operative time ranged from 150 to 240 minutes, with an intraoperative blood loss of 10 to 50 ml, and no intraoperative transfusions were required.Postoperatively, all patients were allowed oral water intake at 6 hours after surgery, followed by a liquid diet on postoperative day 1.The time to first flatus ranged from 1 to 3 days, with an average of 1.57 days, while the time to first bowel movement was 2 to 4 days, averaging 2.86 days.Postoperative pain was mild, with Numeric Rating Scale (NRS) scores on postoperative day 1 ranging from 2 to 4, with a mean of 2.71.The postoperative hospital stay ranged from 4 to 5 days, with an average of 4.29 days.During the 1-to 4-month follow-up period, one patient developed postoperative intestinal obstruction, which resolved with conservative treatment.No cases of stoma infection or hernia recurrence were observed.

Conclusion

Robot-assisted laparoscopic parastomal hernia repair is safe and effective, with a relatively low complication rate and short term recurrence rate, but the long-term effect needs to be further observed.

图1 左下腹造口机器人辅助造口旁疝修补术戳卡布局示意图 注:C 为观察孔;A 为辅助孔; 2 和4 为操作孔,对应机器人2 臂和4臂。SUL 脐与髂前上棘连线, MCL 锁骨中线。
图2 机器人辅助造口旁疝修补术腹腔镜下分离粘连及游离造口肠管后效果。图3 机器人辅助造口旁疝修补术中机器人系统缝合缩窄缺损。图4 机器人辅助造口旁疝修补术机器人系统缝合缩窄缺损后效果。图5 机器人辅助造口旁疝修补术中机器人系统缝合固定补片。图6 机器人辅助造口旁疝修补术机器人系统固定补片完成效果
表1 7 例患者一般资料分析
表2 7 例患者手术及术后恢复情况
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